In this article, learn how to add policy coverages to policy records. Use policy coverages to track additional information about a policy’s product or set of products. Also, learn how to use field sets to change the data you can document for a policy coverage.
IN THIS ARTICLE
Policy records have a Coverages tab that you can use to capture additional information about a policy’s product or set of products.
To add policy coverages:
- Go to the policy record and set a coverage type.
- The coverage type determines which field set is used on the Coverages tab. A field set is a group of data fields that are standard to the health and life insurance industry. In the screenshot below, we selected the “Health” coverage type as an example.
- Go to the Coverages tab.
- In this example, the coverage type is associated with the “Health” field set. This field set is specialized for capturing benefits information on health policies, such as copays, deductibles, Max out of Pocket, and more. In Data & Custom Fields, you can change which field set is associated with the “Health” coverage type. You can also create your own coverage types.
- Associate a carrier product to the policy coverage (optional).
- You can associate an existing carrier product or create new. This allows you to quickly access the product's documents (benefit summary, plan grid, and brochure), if available, on the Coverages tab.
If the product has a coverage template with values, you will have an option to pre-populate its values into the policy coverage fields. This can save you time creating policies for clients with the same benefits.
- Enter coverage details and save when ready.
- Add another coverage (optional).
- A policy can have more than one coverage. For example, a policy might have a health coverage and a prescription coverage. Add as many coverages as you need and change the field set to appropriately match each coverage.
When adding carrier products, you may notice them listed under one of three categories in the dropdown menu: Active, Future, or Termed. Placement is influenced by product effective and term dates.
See the table below for more details.
|A product is listed under this category when...
|The product effective date is blank, or less than or equal to today and the product term date is blank or greater than or equal to the product effective date.
|The product effective date is greater than today (up to 95 days greater).
|The product term date is less than today (up to 45 days less). Adding coverage information to policy enrollments.
Adding coverage information to policy enrollments
When adding an enrollment to a group policy, you can include coverage information to indicate the type of coverage that persons covered under the enrollment have. Please note, you can only track this information if the group policy, in question, has at least one coverage and associated carrier product.
What is a field set?
Field sets are a combination of data fields designed to capture relevant coverage information for particular policy types in the life and health insurance industry. The 12 field sets are tailored to contain industry-standard details. For instance, the specific coverages HMO, EPO, PPO, and medical are all under the general field set, or category, of Health.
Benefits of using coverage field sets
Field sets allow you to track and manage detailed policy information based on coverage type. Field sets connect with the coverage type in the system to display specific coverage data fields. As an example, an individual PDP policy can include fields to track Rx Tiers.
Assigning policies to a field set
Field sets are assigned to a coverage type. The selected coverage type on a policy then displays the appropriate field set for that policy. Example: the field set of Drug is assigned to the Coverage Type of PDP through Data Administration. Policies with a PDP Coverage Type are then associated with the field set of Drug. There is no customization of the Policy Coverages screen. Additional data will still have to be added on the Policy Detail page as a Custom Field.
Finding which field set is on a coverage
The field set in use will be stated just beneath the policy tabs on the Coverages page.
Available field sets
View field sets and the data fields assigned below.
|Long Term Care
|Senior Health / RX
Changing a field set on a coverage
Field sets can be changed on a per policy basis.
- Select the “Change the field set for this coverage” beneath the coverage data.
- Review warning to prevent data loss and select the appropriate field set.
- Be sure to save any changes and make sure that there are the necessary data fields to transfer the current data to. Any unsaved data or data that does not have a data field to move to will be lost.
- Select “Preview Change” OR click the red 'x' on the right to cancel.
- Review the new data fields and make sure no data was lost.
- At the bottom, select “Save” to keep the changes or "Cancel" to continue using previous field set.
Terms & Definitions
- Carrier product: The specific insurance plans offered through each carrier.
- Coverage page: Comprised of the data fields assigned by the field set.
- Coverage(s): The specific type and details of a policy.
- Coverage Type: The dropdown selection in Policy Detail that defines a policy.
- Data administration: AMS+ page located in Settings for customizing dropdowns, assigning field sets, and creating/editing Custom Fields.
- Data fields: The industry-specific information brought into the Coverage page by a field set specific to Coverage Type.
- Field set: A combination of data fields designed to capture relevant coverage information for particular policy types.
- Policy Detail: Page that stores data on each policy. It is where the Coverage Type is set for the policy.
- Products Detail: Page that contains specific information for Carrier Products, including descriptions and attachments.